Iowa Claim for Refund (Sales, Use, Excise, and Local Option Tax) 22-009

Claim for Refund (Sales, Use, Excise, and Local Option Tax) 22-009
IA 843 Claim for Refund - Sales, Excise, and Local Option Tax, 22009
IA 843 Refund Return

Sales, Excise, and Local Option Tax
tax.iowa.gov

Complete all sections on the form. Incomplete forms or forms submitted without the required documentation may
be denied by the Department. See page 3 for instructions.
All refund claims must be submitted electronically via govconnect.iowa.gov OR mailed to:
Compliance Services
Iowa Department of Revenue
PO Box 10456
Des Moines IA 50306-0456
Legal name: ________________________________________________________________________________
Doing business as: ___________________________________________________________________________
Current mailing address: ______________________________________________________________________
City: ______________________________________________________ State: __________ ZIP: ___________
Social Security Number (SSN): _____________ Federal Employer Identification Number (FEIN): ____________
Check the box corresponding to the type of refund you are claiming.
☐ Sales tax

☐ Local option sales tax
(Complete schedule on page 2)
☐ Biodiesel production

☐ Construction equipment excise tax
☐ Water service excise tax

☐ Automobile rental excise tax
☐ Electric Fuel

☐ Vehicle fee for new registration (Vehicle Identification Number (VIN): _________________________________

☐ State or local hotel and motel excise tax. County Jurisdiction: _______________________________________
Check the box corresponding to the reason you are claiming a refund, if applicable. See the instructions
for required supporting documentation.
☐ Rack shelving or conveyor equipment
Tax Credit Certificate Number:

_________________________________________
☐ Wind or renewable energy

Tax Credit Certificate Number:
_________________________________________

☐ Data center

☐ Farm machinery or equipment

☐ Manufacturing machinery or equipment

☐ Fuel used in processing or implements of husbandry

☐ Services used in new construction
☐ Grain bins
☐ Resale

☐ Railroad rolling stock
☐ Nontaxable services

☐ Computers or computer peripherals

☐ Iowa Economic Development Authority contract
utilities
Tax Credit Certificate Number:
_________________________________________

☐ Other: Explain in detail the reason(s) a refund is due, including applicable Code section and rule references.
Include additional sheets, if necessary. _________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________

22-009a (10/27/2023)

IA 843 Refund Return, page 2
Name: ________________________________ FEIN or SSN: ______________________________________
Claim period: From _____________________ to ________________ .
Taxpayers may claim refunds up to three years before the date this return is filed with the Department.
Iowa tax schedule
Original Iowa tax paid
(no local option sales tax)

Corrected amount

Iowa tax to be refunded

Local option sales tax schedule
Break down the claim by county. Enter the total local option sales tax to be refunded. Include additional sheets, if
needed.
County in which tax
was paid

Original tax paid

Corrected amount

Local option sales tax
to be refunded

Total:_______________________
Check this box if you agree to have your refund claim reviewed utilizing a statistical sampling method: ................ ☐
More information about statistical sampling in auditing can be found at tax.iowa.gov.
I, the undersigned, declare under penalties of perjury or false certificate, that I have examined this claim, and, to
the best of my knowledge and belief, it is true, correct, and complete. I declare that I am authorized to act on behalf
of the taxpayer, and will only act within my authority.
Signature must be signed by hand or via a digital signature with a digital certificate. Stamped or typed signatures
are not accepted.
Signature: ______________________________________________________________ Date: ______________
Print name: _____________________________________ Title (if business): ____________________________
Phone: ____________________________________________________

22-009b (10/27/2023)

IA 843 Refund Return Instructions
The completed IA 843 Refund Return should be the first page of a submitted claim, followed by all
supporting documentation.
Note: If you want to request a refund for tax
remitted under a sales and use tax permit, you must
file an amended return rather than this form.
Who may file:
This form may be filed to claim a refund related to
sales, water service excise, vehicle fee for new
registration, local option sales, state or local hotel
and motel, automobile rental, construction
equipment, or biodiesel production (motor fuel), or
electric fuel taxes.
The IA 843 may not be used to claim a refund of
withholding tax. Employers must file an amended
withholding quarterly return to claim a withholding
tax refund.
Individuals must file IA 1040 or IA 1040X, as
appropriate, to request a refund of Iowa income tax
withheld.
Individuals: Must provide your Social Security
Number.
Sole proprietors: Must provide a Social Security
Number and a Federal Employer Identification
Number, if applicable.
Partnerships and corporations: Must provide
your Federal Employer Identification Number.
Local Hotel and Motel Jurisdiction: More
information about local option jurisdictions is
available at tax.iowa.gov in the Iowa Local Option
Tax Information section.
Who must sign:
If a claim is filed for a corporation, the claim must
be signed either by an officer or by another
authorized representative of the corporation. If an
attorney or agent is filing the claim on behalf of the
claimant, a power of attorney (original) authorizing
the attorney or agent to sign must be submitted
with the claim. A power of attorney should clearly
identify who is to receive the refund check and
where it should be mailed.
Provide the following required supporting
documentation:
Sales tax, water service, state or local hotel and
motel, construction equipment, electric fuel,
and automobile rental: Provide copies of the
invoices, exemption certificates, credit memos,
and any other supporting documentation
applicable.

22-009c (10/27/2023)

Vehicle fee for new registration: Copies of the
original bill of sale, the title, the registration showing
the fee was paid, and any additional supporting
information. Note: The vehicle identification number
(VIN) must be entered on the first page of this claim.
Local option sales tax: Copies of all invoices
verifying that local option sales tax has been paid.
Biodiesel production: The number of biodiesel
gallons produced during each quarter.
Rack shelving or conveyor equipment: A tax
credit certificate number.
Fuel used in processing or implements of
husbandry: An energy study to determine the
exempt percentage, copies of all invoices, and a
schedule of energy used. Explain how the
equipment using the fuel is used in processing or
an implement of husbandry and describe the
tangible personal property to be sold at retail.
Farm
and
processing
machinery
and
equipment: Copies of all invoices. Explain how
each item is used directly and primarily in
agricultural production or in processing.
Computers and computer peripherals: Copies of
all invoices. Explain how they are used in
processing or storing data and describe your type
of business or occupation.
Wind and renewable energy: Tax credit certificate
number and copies of all invoices.
Iowa
Economic
Development
Authority
contract utilities: Tax credit certificate number
Data center: An affidavit and copies of all invoices.
Where is my sales tax refund?
Call 515-725-1104
Questions?
Phone: 515-281-3114 or 800-367-3388
8:00 a.m. – 4:30 p.m. CT
Email: [email protected]